The Surgeon: Several Years Later

Ann Lowell woke up half an hour before her alarm was set to go off. She made a half-hearted attempt to go back to sleep, but quickly realized it was futile and turned off her alarm. She rubbed her eyes as she sat up in bed and faced her room, taking stock in her surroundings. The single room she occupied reeked of “medical student.” Her Ikea bookcase was filled with gross anatomy manuals, pathophysiology textbooks, and flashcards; on top of the bookcase was a rubber model of a human brain, flanked by a rubber kidney and her first stethoscope. Her desk was cluttered with notes from her various classes, nearly burying her laptop computer. The piece de resistance of the room was, as always, Ann’s three foot tall scaled skeleton that she had nicknamed “Jack.”

In many ways, this was the same room that Ann had faced every day for the last two years. But today was different in one very important way. Today she was a third year medical student and would finally be released into the hospital to treat and follow real life patients. The lessons she had learned so well on paper were about to spring to life. And Ann couldn’t wait.

Ann nearly bounced into the shower, getting a good steam going long before her roommate, fellow med student Lori Dougherty, had even woken up. After her shower, Ann brushed her teeth as she stared at herself through the haze of moisture on the bathroom mirror. “Hello, Dr. Lowell,” she said to the mirror. She smiled.

Ann decided to pull her straight black hair back into a sensible bun. She thought it made her look older and more mature than her twenty five years. Most women would have shied away from anything to make them look older, but Ann knew she had a youthful appearance and no patient respected a doctor who looked like she should still be in high school.

The night before, Ann had selected a pair of tan slacks and a white blouse to wear for today. She debated whether or not to wear a skirt, but decided she didn’t want to call attention to her femininity. She wanted to be part of the team, not a pair of good legs. Besides, she had nightmares of getting a rip in her pantyhose.

The last clothing item was her short white coat. The white coat was the ultimate symbol of the doctor. They wore the long white coats and medical students wore short coats to convey their trainee status. Ann had worn the coat only a handful of times so far, during structured patient encounters. But from now on, she would be wearing a white coat every single day.

She pulled on the white coat and took a long, deep breath. You can do this. You know just as much as any other third year medical student. Probably more. The patients are going to love you.

She checked herself one last time in the full-length mirror in her room, examining her slim five foot frame for any loose threads or other imperfections. Satisfied she looked presentable, she threw back her shoulders. “Just don’t screw up,” she said aloud.

Ann arrived at the hospital nearly 45 minutes before the time that had been specified on their orientation sheet for the general medicine rotation. She was supposed to show up at the department of medicine conference room, but the door to the room was still locked. She checked the department of medicine and found a bewildered secretary at her desk.

“I’m a medical student,” Ann announced. “I was supposed to show up here for orientation.”

The secretary stared at her. “You were supposed to show up at 8:15.”

“I know,” Ann said.

“It’s 7:30,” the secretary pointed out.

“I’m a little early,” Ann admitted.

“Quite the gunner, aren’t you?” the secretary laughed. She struggled to her feet. “All right, hon, I’ll let you in. I’m Trish, by the way.”

“I’m Ann Lowell,” Ann said.

“Oh, Ann, yes…” Trish shuffled through some papers on her desk. “Yes, of course… you’re assigned to Red Medicine.”

“Red Medicine?”

Trish nodded as she brushed past Ann on her way to the conference room, holding the keys. “All the teams are named after colors. That’s just the way we distinguish them.”

“I see… and who is the attending physician?” The attending physician was the doctor “in charge” of running the team.

“Oh, you’re in for quite a ride, Ann,” Trish said with a wink. “I believe Dr. Dergan is the attending on Red this month.”

“Who’s Dr. Dergan?” The name didn’t sound familiar to Ann. He hadn’t taught any of their lectures during the first two years.

“You’ll see,” Trish said as she unlocked the door. “My advice to you is not to let him get to you. He’s only been attending here for two years and he’s already sent his share of med students home crying. Just don’t take him too seriously.”

“Crying…” Ann’s eyes widened. She didn’t like the sound of that.

Trish shrugged. “He used to be a surgeon so he still has that mentality, you know?”

Ann sunk into her seat, trying not to think about what Trish had just told her, but it was almost impossible. She felt goosebumps break out on her skin and she felt her hands start trembling. Calm down, how bad can he be?

Before she had started third year, Ann had heard horror stories from upperclassmen about difficult attendings. She heard how they would “pimp” the medical students—asking them multiple difficult questions on a topic in front of the whole team. Ann had always wondered how she’d stand up to that kind of questioning. When she got called on in class, she was usually prepared with the answer, but getting called on was a rare occurrence. For most of her life, she had been proving her intelligence on exams. She had never been in an atmosphere like this before.

Gradually, the other students filed into the room. The course director for the third year medicine clerkship Dr. Howard arrived promptly at 8:15AM to greet the new students. He took down everyone’s name before he began his own introduction.

“First, I want to welcome you to your very first clerkship,” Dr. Howard said. “I know some of you are probably very nervous, but I want to reassure you that medicine isn’t a bad way to start. Most of the attendings in our department are very nice and very eager to teach. Most, although unfortunately not all.” Dr. Howard snickered at his own joke. Ann wondered if it was her imagination that he was looking in her direction as he spoke. “Anyway, I’ve made copies of the schedule for all of you. Morning report is at 8AM every morning so you should have finished pre-rounding on all of your patients before then. Attending teaching rounds start at 9AM and generally last until noon, but can sometimes go longer. I expect you to be here on either Saturday or Sunday every weekend. If you need an entire weekend off for whatever reason, you must work both days the prior or subsequent weekend. Call is every fourth night, and we allow medical students to go home at 11PM. Since you’re not expected to stay overnight, you don’t get to leave early on your post-call day.”

Wow, this is the real thing, Ann thought to herself. Part of her was excited but part of her wanted to run for the hills before it was too late. Only a few weeks earlier, she had been a student, sitting through countless lectures. Now they were treating her like a doctor.

Dr. Howard talked about the lecture schedule and various other matters, then looked up at the clock. “Well, it’s almost nine o’clock. Why don’t I bring you to your teams and you can round with them?”

As it turned out, Ann was the only medical student assigned to Red. She bitterly wondered why she was so lucky.

“Ann, your team meets up on the sixth floor, by the nurse’s station,” Dr. Howard said. “Do you think you can find that?”

Ann nodded. She didn’t trust herself to speak anymore. Her stomach had twisted into a knot. She had never felt so nervous in her life. You can do this, Ann. Stop being such a wuss.

It wound up being a little harder than she had thought to find the nurse’s station on the sixth floor. Ann found herself wandering around, too timid to ask for directions. She might have wandered around for another hour if a very pretty Asian girl in a long white coat hadn’t taken her gently by the arm. “You look lost,” she commented. “You must be a med student.”

Ann flashed the other girl a grateful smile. “I’m looking for the Red Team,” she said.

“I’m Ann,” she said, shaking Cody’s hand. “So um… where are we supposed to meet?”

“Right here,” Cody said, a disarming smile spreading across her tanned face. “The rest of the team will be along soon... Dr. Dergan is usually late. Don’t look so nervous, Ann. Nobody is going to bite you, I promise.”

Ann tried to return the smile, but she was afraid it came out as a grimace. “It’s just… I heard some bad stuff about Dr. Dergan…”

Cody rolled her eyes. “Yeah, he’s definitely tough. He’s got that whole mentality where he feels like part of the medical training is to… well, torture you a little.” She laughed at the expression on Ann’s face. “It’s really not as bad as it sounds… I mean, he’s right that you learn more this way. It keeps you on your toes. And nobody expects you to know very much anyway. You’re just a third year medical student.”

“I heard he’s made medical students cry…”

“Only the ones who weren’t prepared,” a male voice said from behind her.

Ann felt her face flush. Great, why did I start talking about my attending when I knew he’d be here any second? She took a deep breath and turned around, expecting to look up at a stern, gray-haired man glowering down at her. Instead, she was surprised to find that she had to look down at her new attending, which was unusual for Ann with her height of barely five feet. Dr. Dergan sat in a wheelchair.

He was much younger than she had expected too. He was probably in his early thirties, not that much older than she was, with light brown hair and penetrating brown eyes. If she weren’t so terrified of him, she would have thought that he was pretty cute. There was a stethoscope hanging around his neck and he wore a dark blue shirt that couldn’t hide the muscles in his shoulders or the slight paunch of his abdomen. Brown slacks covered thin legs that appeared motionless.

The wheelchair itself was relatively unassuming. Unlike the hospital chairs, the backrest barely came up to the small of his back. There were no armrests and there was only one central footplate where his brown loafers rested peacefully.

“Hi, Dr. Dergan,” she stammered. “I’m Ann Lowell.”

“The medical student,” he said. He nodded at her. “We’ll give you a patient or two today, don’t worry.” He looked her over, sizing her up. “I promise I’ll try not to make you cry.”

Ann blushed all over again, but decided it was best to remain silent.

The rest of the team arrived shortly. There was another intern on the team named Sheldon, and there was a senior resident named Raj. They both seemed nice enough, but Ann was still shaking from her introduction to Dr. Dergan.

This was the first time Ann had experienced “rounds” and she found herself quite overwhelmed. The team went from room to room, stopping at the door of every patient covered by Red Medicine. The intern would give a short presentation of each patient, then give an update of how they were doing. At that point, Dr. Dergan would ask questions about the patient and make management decisions.

Dr. Dergan interrupted Sheldon in the middle of summarizing his first patient. “Why don’t you give the whole story on the patient… for the sake of our new medical student.”

Ann felt flattered that Dr. Dergan had thought of her, but she was anxious that there was an underlying motive, such as he was planning to quiz her later. She tried to concentrate on Sheldon’s presentation, but a lot of what he was saying sounded like jargon to her. She felt like she was missing every other word, which made the presentation very hard to follow.

Her mind began to wander and she caught herself looking down at Dr. Dergan’s legs again. She noticed how still they were and how they bounced slightly when he wheeled his chair. She guessed he must have had a spinal cord injury of some kind. She noticed that there was a belt across his waist and his protruding gut hung over the belt slightly. Probably lost his abdominal muscles too, she guessed. There was something strangely intriguing about his lower body.

“Do you have any questions, Ann?” Dr. Dergan was looking at her now, his eyebrows raised.

Ann had so many questions, she wouldn’t have known where to begin. “No.”

“You can’t learn if you don’t ask questions,” he said, but to her relief, he didn’t press the matter. “Well, I’ve got a question: what do you want to be when you grow up, Ann?”

She hadn’t been asked the question that way since she had declared herself to be pre-med in college. “I want to be a surgeon,” she said.

“A surgeon, really?” Dr. Dergan looked surprised, but not displeased. She remembered that Trish had mentioned that he used to be a surgeon and wondered what had happened. “Pretty unusual for a woman. You won’t have much time to spend with your kids.”

Ann tried to ignore the chauvinistic insinuations of his comment. “I don’t want to have kids,” she replied honestly. It was a decision she had made many years ago. “I just want to be a doctor.”

To her surprise, Dr. Dergan smiled at her. She couldn’t help but think that he had a really sexy smile. “We have something in common then, Ann.”

The team rounded on another few patients. Ann did her best to pay attention, but her anxiety distracted her. She zoned out until she heard Dr. Dergan saying her name. “This is a good patient for you to take, Ann.”

“Huh?” Ann said, before she could stop herself.

Dr. Dergan gave her a strange look, then shook his head. “This is a new patient that Dr. Hwa just picked up this morning. You can follow the patient with her.”

Cody was nodding vigorously. “I think it’s a really good patient for us to follow together, Ann. It’s a good case of upper GI bleed.”

Ann felt her insides freeze up. She knew everyone on the team was staring at her, but her mind was drawing a blank. She looked over at Cody, who was mouthing the words, “Peptic ulcer disease.”

“Peptic ulcer disease?” Ann said.

“Okay, what else?”

Cody was mouthing something else that Ann couldn’t make out. She finally hung her head in shame. “I don’t know.”

“Really?” Dr. Dergan was frowning at her. “All right, Ann… I’ll give you a day. Tomorrow in rounds I want you to tell me the full differential diagnosis of an upper GI bleed.”

Ann nodded.

“All right, and now we’re going to do a physical exam on the patient.”

Dr. Dergan wheeled himself into the patient’s room. She noticed that when he went through doors or in a crowded area, he often grabbed on to things to propel himself forward. She supposed that was a trick he had learned to get around easier.

The patient, Mr. Jameson, was a man in his sixties who reeked of stale cigarette smoke. He had a five o’clock shadow of gray hairs across his chin. “What’s all this now?” Mr. Jameson said in a gruff voice.

“Yeah? Well, good for you, doing that with being crippled and in a wheelchair and all.”

Ann could tell that Mr. Jameson didn’t mean any offense, but she felt the awkwardness in the room. She was surprised when Dr. Dergan simply brushed off the remark. “Have you been throwing up any more blood?” he asked.

“Nah, not since that first bit.”

He asked some questions about abdominal pain and length of his symptoms, past medical history, and social history. Then when he was finished with his questions, he said: “Okay, Mr. Jameson, would it be all right if I examined you with our medical student Ann?”

“Sure, go for it,” Mr. Jameson agreed.

Dr. Dergan pushed an IV pole out of the way in order to get his wheelchair around to the side of the bed. Ann stood on the other side as they listened to the back of the patient’s chest in tandem. Ann noticed that Dr. Dergan had to stretch in order to reach the upper part of the back. She also noticed the way he held the stethoscope with his palm rather than with his fingers. “What do you hear?” he asked her.

Ann hesitated. “Um… it sounded… clear…”

Dr. Dergan’s eyes narrowed. “Yeah? You heard good breath sounds?”

“Um…”

“Mr. Jameson, are you a smoker?” Dr. Dergan asked him.

“Uh huh,” Mr. Jameson grunted.

“You need to quit, Mr. Jameson. I can already hear it in your lungs.” Dr. Dergan looked back at Ann. “Sounded to me like decreased breath sounds bilaterally, probably due to some chronic obstructive pulmonary disease from smoking,” he said. “What do you think, Dr. Hwa?”

Oh no, Ann thought as she felt the tears rise in her eyes. This was the very thing she had been terrified of—crying in front of the attending. Dr. Dergan noticed her reaction and cocked a finger at her. “Come on, let’s go outside.”

The rest of the team waited outside while Dr. Dergan gestured for Ann to go sit down in the nurse’s station. He wheeled over to her and waited patiently as she wiped her eyes and composed herself. She wished he would just leave her alone. All she wanted right now was to run out of the hospital and never return.

“Are you okay now?” he asked her.

She nodded.

She expected him to say some kind words to her now, but instead he just looked her straight in the eyes and said: “Ann, you have a lot of learning to do. I know it’s only your first day, but what I saw in that room is not the attitude or knowledge level of a future surgeon.”

Ann nodded. She knew he was just being honest with her, but the words really stung. She didn’t think she’d ever forget him saying that to her, not if she lived to be a hundred. I hate you, she thought.